特发性血小板减少性紫癜的病因及疗效探讨被引量：16

Exploration of the cause and efficacy of idiopathic thrombocytopenic purpura

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摘要目的 :探讨特发性血小板减少性紫癜 (ITP)的病因与疗效的关系。方法 :对 16 0例ITP患者的临床及实验室资料进行回顾分析 ,分 4组采取 4种治疗方法 :A组 :抗幽门螺旋杆菌 (HP)加地塞米松冲击继之泼尼松治疗 ;B组 :泼尼松加大剂量丙种球蛋白冲击治疗 ;C组 :泼尼松加达那唑治疗 ;D组 :难治性的给以睥切除治疗。按显效、良效、有效、无效评价治疗效果。结果 :急性ITP 90例 ,慢性ITP 70例 ,男 5 5例 ,女 10 5例 ,男女之比为 1∶2 ,就诊时中位年龄 39岁 ,均有出血表现 ,中位PLT数 15× 10 9/L。有HP感染 75例 ,血小板表面抗体 (PAIGg)阳性 90例 ;血小板自身抗体阳性 30例 ;骨髓巨核细胞增多 114例 ,正常 35例 ,减少 10例 ,巨核细胞均以颗粒巨核细胞为主。T细胞亚群分布以CD4 /CD8降低为主。 4种治疗效果以抗HP加地塞米松冲击继之泼尼松治疗和泼尼松加大剂量丙种球蛋白冲击治疗为好 ,泼尼松加达那唑治疗次之。前两种治疗与后两种之间差异有统计学意义 ,均 P <0 .0 1。结论 :HP感染及自身免疫因素的异常是ITP发病的直接病因。抗HP、激素。 Objective:To explore the relationship of the causes and the efficacy in ITP.Method:160 ITP patients diagnosed from January 2000 to December 2003 in our department were retrospectively analyzed. To adapt four kinds of treatment: A: antihelicobacter-pylori plus highdoses dexamesone follow predisone; B: predisone plus highdoses immuneglobulins; C: predisone plus danazol; D: splenectomy to treat refractory ITP. To evaluate the therapeutic outcome according to recovery, efficacy, advancement and inefficacy.Result:Acute ITP 90 cases, chronic ITP 70 cases, male 55 cases, female 105 cases, male to female ratio of 1∶2 and a median age of 39 years, most of the patients had severe hemorrhagic symptoms. Median platelet count is 15×10 9/L. 75 cases had helicobacter pylori infection, 90 cases platelet associated immuneglobulin (PAIgG) was positive, 30 cases platelet autoantibodies was positive, 114 cases increased in the number of megakaryocytes, 35 cases were normal and 10 cases were decreased, the most of megakaryocytes were immature megakaryocytes. T-cell subset distribution showed CD4/CD8 decreased. Compared with the four kinds of treatments, antihelicobacter-pylori plus highdoses dexamesone follow predisone and predisone plus highdoses immuneglobulins were better than predisone plus danazol. There were significient difference between the front two kinds treatments and the behind two kinds treatments (P< 0.01).Conclusion:The direct causes of ITP may be helicobacter pylori(HP) infection and autoimmune abnormality. Antihelicobacter-pylori, hormone、highdoses immuneglobulins both could be an ideal treatment choice.

作者庞丽萍杨保青孟庆祥柳金张红宇王钧虞积仁郭乃榄魏颖慧彭艳红彭小艳

机构地区北京大学深圳医院血液科

出处《临床血液学杂志》 CAS 2005年第1期11-13,共3页 Journal of Clinical Hematology

关键词紫癜血小板减少性特发性病因 Efficiency Thecause Icliopathic thrombocytopenic purpura

分类号 R554.6 [医药卫生—血液循环系统疾病]

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